EKG interp

zmedic

zmedic

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Christopher said:
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Click to expand...

Also the QRS is getting pretty wide. Maybe it's PVCs or a ventricular rhythm, but I would worry about things that widen the QRS like TCA overdose or hyperkalemia. It's getting a bit sine wavey.

But the big thing is if you are going to look at a rhythm strip you should have 3 leads, and a longer strip, like 6-10 seconds worth, or a QRS. One lead is basically "is this Vtach/Vfib?"
 
VFlutter

VFlutter

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MSDeltaFlt

MSDeltaFlt

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As far as the 1st goes, can't say much without a 12 lead. So with the little info we have, I'd also say IVR /c PVC's; some perfusing and some not as made evident by SpO2 pleth.

As far as the 2nd goes, I would also call that Controlled A-Flutter at 60. I would not call that 3AVB. The only AVB I've ever seen that incorporated anything similar to A-Flutter is a High Grade Block which is even lower in the heart with an intrinsic rate of around 15bpm. And the complexes are very wide. It has been my experience and training that if they have a pulse, the won't have much of a BP.
 
VFlutter

VFlutter

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I totally understand it looks like A Flutter but by definition if the atrial rate is over 400 bpm then it is A Fib, which in that strip it is. Just like if the atrial rate was under 250bpm it would be Atrial Tach. "Regularized A Fib" with a QRS resembling an escape rhythm is suspect for a 3rd degree AVB.
 
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Merck

Merck

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Well I have to respectfully disagree. The second strip is likely an A Flutter. Leads V1 and V2 show what morphologically appear to be pretty clear flutter waves with a rate of perhaps slightly over 300. V1 an V2 are probably the best views for the atria and provide the most reasonable interpretation. And while I'm sure that is a fine website for ECG interpretation I just have to disagree. Type 1 atrial flutter for sure.
 
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46Young

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zmedic said:
Also the QRS is getting pretty wide. Maybe it's PVCs or a ventricular rhythm, but I would worry about things that widen the QRS like TCA overdose or hyperkalemia. It's getting a bit sine wavey.

But the big thing is if you are going to look at a rhythm strip you should have 3 leads, and a longer strip, like 6-10 seconds worth, or a QRS. One lead is basically "is this Vtach/Vfib?"
Click to expand...

I was thinking hyperkalemia myself. Take a look at these images:

http://images.google.com/search?num....epsugrpq2..0.0...1.1.TqtehK7Ok3c&safe=active

Like Bob Page says, "In lead II you got no clue!"
 
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bigbaldguy

bigbaldguy

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Follow up from my instructor on posted strip. Names removed. Second opinion from two experienced medics with advanced training in EKG interp and an MD.

Ok gang if you are still following this post I spoke with Dr. Xxxx, xxxx and future Cardiologist Xxxx xxxxx And we concur that this patient is screwed!! The rhythm does not match any rhythm definition exactly. So the possibilities exist that it is a Block of some sorts, Afib with bigeminy, a funky Ventricular pacemaker and lastly an Acc. IVR. The take home point is treat your patient, the rate and the blood pressures.
 
Christopher

Christopher

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Looks like a cycle length of 880 ms or 68 bpm without the "FLB's", a cycle length of 1360 ms or 44 bpm with the "FLB's in between", and a pulse oximetry signal latency (QRS-nadir to pulse oximetry nadir) of 1440 ms.
Durations+Markup.jpg

Need a 12-Lead to ensure the FLB's are actually....beats :)
 
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bigbaldguy

bigbaldguy

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Wow I have no idea whatnthenhell that is but it looks like you put a lot of effort into it so nice job :).
 
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MJG

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bigbaldguy said:
Follow up from my instructor on posted strip. Names removed. Second opinion from two experienced medics with advanced training in EKG interp and an MD.

Ok gang if you are still following this post I spoke with Dr. Xxxx, xxxx and future Cardiologist Xxxx xxxxx And we concur that this patient is screwed!! The rhythm does not match any rhythm definition exactly. So the possibilities exist that it is a Block of some sorts, Afib with bigeminy, a funky Ventricular pacemaker and lastly an Acc. IVR. The take home point is treat your patient, the rate and the blood pressures.
Click to expand...

Well, then i haven't been so far off after all :)

Do you know this site? http://en.ecgpedia.org/wiki/Main_Page
Maybe you'll find some extra information there, but I'm afraid you won't get far without a 12-lead ECG.

Cheers!
 
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